Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2024-09-22 DOI:10.1111/jon.13238

Adnan I. Qureshi, Yilun Huang, Ibrahim A. Bhatti, Camilo R. Gomez, Daniel F. Hanley, Daniel E. Ford, Ameer E. Hassan, Thanh N. Nguyen, Alejandro M. Spiotta, Erol Veznedaroglu, Ronald F. Budzik, Rishi Gupta, Raul G. Nogueira, Antonin Krajina, Bruno Bartolini, Joey English, Blaise Baxter, David S. Liebeskind

{"title":"Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke","authors":"Adnan I. Qureshi, Yilun Huang, Ibrahim A. Bhatti, Camilo R. Gomez, Daniel F. Hanley, Daniel E. Ford, Ameer E. Hassan, Thanh N. Nguyen, Alejandro M. Spiotta, Erol Veznedaroglu, Ronald F. Budzik, Rishi Gupta, Raul G. Nogueira, Antonin Krajina, Bruno Bartolini, Joey English, Blaise Baxter, David S. Liebeskind","doi":"10.1111/jon.13238","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Purpose</h3>\n \n <p>Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (<i>p</i> = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (<i>p</i> = .34). Among patients who received IV thrombolysis (<i>n</i> = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (<i>p</i> = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.</p>\n </section>\n </div>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":"34 6","pages":"773-780"},"PeriodicalIF":2.3000,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuroimaging","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jon.13238","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Purpose

Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.

Methods

We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.

Results

A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.

Conclusions

In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

血栓切除术治疗急性缺血性脑卒中后辅助动脉内溶栓的脑内出血风险。

背景和目的：越来越多的急性缺血性卒中患者考虑将动脉内溶栓作为机械取栓术的辅助手段，以加强再灌注。在某些患者亚群中，动脉内溶栓可能会增加血栓切除术后脑内出血（ICH）的风险：方法：我们分析了在多中心登记中接受机械溶栓治疗的急性缺血性脑卒中患者。血栓切除术后任何（无症状和有症状）ICH的发生都是根据标准定义确定的，要求在血栓切除术后48小时内进行连续的神经系统检查和计算机断层扫描。我们根据临床特征和静脉（IV）溶栓的使用情况确定了亚组的 ICH 风险：在 1953 名接受机械血栓切除术的急性缺血性脑卒中患者中，共有 146 名（7.5%）患者接受了动脉内溶栓治疗。接受和未接受动脉内溶栓治疗的患者中，发生任何 ICH 的比例分别为 26 例（17.8%）和 510 例（28.2%）（p = .006）。接受和未接受动脉内溶栓治疗的患者中，出现症状性 ICH 的比例分别为 4（2.7%）和 30（1.7%）（p = .34）。在接受静脉溶栓治疗的患者（n = 1042）中，接受和未接受动脉内溶栓治疗的患者发生任何 ICH 的比例分别为 9（16.7%）和 294（30.7%）（p = .028）。根据年龄、性别、闭塞位置、术前美国国立卫生研究院卒中量表评分、症状出现与血栓切除术之间的时间间隔、阿尔伯塔省卒中项目早期CT评分、收缩压和血清葡萄糖浓度等因素确定的分层风险没有差异：在接受机械血栓切除术的患者中，动脉内溶栓不会增加任何 ICH 和症状性 ICH 的风险，包括那些已经接受过静脉溶栓治疗的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!